Patient Account Specialist - Revenue Cycle PB Billing & Denials

Patient Account Specialist

Minimum Qualifications:  

High School Diploma or equivalent. Two years of financial experience or one year of patient accounts experience.

Licenses, Registrations, or Certifications:

High School Diploma or equivalent.

Preferred Qualifications:

These are agreed upon during the creation of a new posting with the hiring manager. They need to be verifiable. ( Example: Masters Degree, 5 years of experience )

Job Summary/Description:

The Patient Account Specialist will be responsible for billing all third party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to insure timely and appropriate reimbursement and account resolution.

Job Duties:

• Demonstrates a level of competence and understanding of all state and federal laws,

rules and regulations regarding payer billing guidelines

• Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as

POS requirements

• Billing payers and/or clients for hospital and/or Professional Patient Accounts

• Resolves Payer rejections from billing system daily to bill submit hospital and/or

physicians claims

• Performs online corrections to edited claims according to procedures

• Performs detailed follow-up activities on assigned accounts according to procedures

• Responds to daily correspondence according to procedures

• Identifies denials and underpayments for appeal

• Reviews, researches and processes denied claims

• Appeal claims as appropriate according to policies and procedures

• Updates account information and documents as appropriate within Epic Resolute

• Processes account adjustments according to policies/procedures

• Issues payer and/or patient refunds according to policies/procedures

• Validates accuracy of payments and/or adjustments on accounts

• Resolves outstanding accounts at required accuracy and productivity requirements

• Maintains comprehensive knowledge of the work unit assigned

• Assists in the development of department policies and procedures

• Adheres to established policies and procedures

• Adheres to internal controls and reporting structure

• Maintains open and professional communication with customers, colleagues and vendors

• Performs well in a team environment

• Successfully completes competency based training and testing

• Prioritizes and completes all work in an accurate, effective and efficient manner

• Assists in the training and mentoring of new employees

• Reads all announcements and relevant communications relating to job duties

• Performs related duties as required.

• Participates in team meetings/activities and supports the philosophy and goals of the

team and department

Salary Range: 

Actual salary commensurate with experience or range if discussed and approved by hiring authority.

Work Schedule:

Partial remote, onsite position as needed position must be a Texas resident. 8am to 5pm, and as needed on occasion.